Organization
LARK REXALL DRUGS INC
Active
Other names
LARK DRUGS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMALIA NICOLA PHARMACY TECH (PRESIDENT/OWNER)
(707) 869-9055
Entity
Organization
Contact information
Practice address
16251 MAIN ST, GUERNEVILLE, CA 95446-8300
(707) 869-9055
(707) 869-9203
Mailing address
16251 MAIN ST, GUERNEVILLE, CA 95446-8300
(707) 869-9055
(707) 869-9203
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY 51871
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY 51871
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135347
MEDICARE (IMMUNIZATIONS)
CA
01
—
1750484820
MEDI-CAL PROVIDER NUMNER
CA
01
—
PHY 51871
CALIFORNIA STATE BOARD OF PHARMACY LICENSE
CA
Enumeration date
09/06/2006
Last updated
03/25/2015
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